Bell Overspray / Fallout Sample Form
(This form to accompany submitted overspray / fallout samples. Please call at least 24 hours before sending samples to expedite analysis turnaround; 281-488-3701 ext:12)
Client:  _______________________________________________________________ Address:  _______________________________________________________________ Project Number / Claim #:  ________________________________________________ Location of Incident (City, State):  _________________________________________ Contact:  __________________________  Fax: __________________________ Office:  __________________________  Alternate: __________________________   Reference Sample Identification Ref #1   Ref #4 Description and Location of sample   Description and Location of sample _________________________________   _________________________________ _________________________________   _________________________________ _________________________________   _________________________________ _________________________________   _________________________________       Ref #2   Ref #5 Description and Location of sample   Description and Location of sample _________________________________   _________________________________ _________________________________   _________________________________ _________________________________   _________________________________ _________________________________   _________________________________       Ref #3   Ref #6 Description and Location of sample   Description and Location of sample _________________________________   _________________________________ _________________________________   _________________________________ _________________________________   _________________________________ _________________________________   _________________________________

Send Samples to: E. Lynn Shirey, Bell Evaluation Laboratory, 17300 Mercury, Houston, TX 77058